The final “doc fix” bill, HR 2 “The Medicare Access and CHIP Re-authorization Act of 2015” was signed into law on April 16, 2015. This legislation was designed primarily to address the physician fee schedule and previously mandated cuts, but law makers took the opportunity to include several important changes affecting the DME industry. One of the most notable was the removal of the restriction on who can conduct a Face-to-Face (FTF) encounter for DMEPOS equipment.In the final FTF rule for DME; NPs, PAs and CNSs were required to have a physician sign off on all face-to-face encounters for DME. This caused quite the commotion as NPs, PAs and CNSs have always been able to independently prescribe DME and conduct visits. In some states and rural areas, NPs operate their own practices without an attending physician. Therefore getting a physician sign off significantly increased the administrative burden of FTF implementation. In large part, due to this requirement, CMS opted to delay enforcement of a part of the FTF rule.

In the “doc fix” bill section 1834(a)(11)(B)(ii) of the Social Security Act was amended to remove the restriction and expand the parameters to make NPs, PAs and CNSs eligible to complete and document the face-to-face encounter for DMEPOS equipment. For suppliers, this change will likely expedite the enforcement of Phase II of the FTF Rule.Currently, the implementation of the FTF rule has been broken down into two phases:

Phase I- Requires a face-to-face visit take place within the 6 months preceding the date of the detailed written order, and that the supplier secure a compliant, Detailed Written Order Prior to Delivery (DWOPD). The DWO must be date stamped by the supplier prior to delivery of any item subject to the ruling.

Phase II – Requires suppliers to obtain executed copies of the FTF visit (performed within 6 months of the date on the DWOPD). The FTF notes must be signed and dated by the physician and then date stamped by the supplier prior to delivery of the DMEPOS item subject to the ruling.

While the original FTF rule became effective in November 2012, enforcement was initially delayed. CMS then came back and announced enforcement of Phase I of the ruling for dates of service on and after January 1, 2014. Since then, enforcement of Phase II has been delayed without any indication of when it would be implemented. However, this new provision in the “doc fix” bill eliminates the last foreseeable barrier to implementing the second phase.With the roadway cleared, we speculate that CMS will begin Phase II enforcement soon. The new law specifically addresses implementation in Title V. Sec. 504 (b). In this section, the law states that the Secretary of Health and Human Services may implement the amendments [the inclusion of NPs, PAs and CNSs] by program instruction or otherwise. This means that the final rule for the FTF does not need to be amended in order to move forward with implementation. We expect CMS to initiate an announcement in the weeks ahead.Many suppliers are already complying with this rule, collecting medical necessity documentation from the face-to-face encounter before the product is delivered. But many are not ensuring that the record is fully authenticated upon collection. This will be a requirement upon enforcement of Phase II. If you are not already complying with both phases of the Face-to-Face, we strongly recommend moving forward. Keep in mind that many items that are subject to the FTF rule are also currently under pre-payment review in several jurisdictions (CPAP for example). Once Phase II is enforced, if you have delivered your equipment AND billed your claim without compliant documents in hand, Medicare will refuse all future payment to that NPI. While there are provisions that allow correction of errors identified in the DWOPD and FTF documentation when identified prior to claim submission, once the claim is submitted the errors are incurable and the beneficiary must seek service through a different provider.Also, as a reminder, be sure to include a valid date stamp on your documentation. Auditors will rely on the date of receipt to validate that your documentation was in hand prior to delivery.If you need more information on the phases of FTF and how your business will be impacted, check out our on-demand recording “Face-to-Face in the Real World: How to Comply In Its Current Form”.